| Krista Kulesza, Ph.d., Llc | |
|
305 Miron Dr Southlake TX 76092-7831 | |
| (682) 554-2946 | |
| (866) 573-1719 |
| Full Name | Krista Kulesza, Ph.d., Llc |
|---|---|
| Speciality | Psychologist |
| Location | 305 Miron Dr, Southlake, Texas |
| Authorized Official Name and Position | Krista Kulesza (LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 6825542946 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Krista Kulesza, Ph.d., Llc 305 Miron Dr Southlake TX 76092-7831 Ph: (682) 554-2946 | Krista Kulesza, Ph.d., Llc 305 Miron Dr Southlake TX 76092-7831 Ph: (682) 554-2946 |
| NPI Number | 1578982401 |
|---|---|
| Provider Enumeration Date | 04/08/2014 |
| Last Update Date | 04/08/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578982401 | NPI | - | NPPES |
| 312422401 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 33605 (Texas) | Primary |
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